Provider Demographics
NPI:1790855179
Name:GIBSON, SHARON WRAY (MT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:WRAY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4004
Mailing Address - Country:US
Mailing Address - Phone:209-830-1702
Mailing Address - Fax:209-830-1702
Practice Address - Street 1:120 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4004
Practice Address - Country:US
Practice Address - Phone:209-830-1702
Practice Address - Fax:209-830-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist